Report Form | Fraud, Waste & Abuse

Use this form to report suspected health care fraud perpetrated by a doctor, hospital or other health care professional. To help us address the issue, please supply as much detail of the suspected illegal activity as you can. Referrals are held in strict confidence.

If you believe you are the victim of identity theft, please contact local law enforcement as well as your insurance company’s Member Services; the number can be found on your insurance card. You may also wish to review information on the Federal Trade Commission website (www.ftc.gov), as that agency is involved with consumer protection.

Note that a complaint about a doctor, hospital, or service at a lab or pharmacy is not necessarily fraud. If you wish to make a complaint about the quality of your doctor’s service, have a problem with your bill, or have found something incorrect on your explanation of benefits (EOB), please contact your insurance company’s Member Services; the number can be found on your insurance card.

Are you reporting for someone else? Yes No

Is this related to Medicaid? Yes No

Is this related to Medicare? Yes No

Is this related to dental services? Yes No

Is this related to prescription medications? Yes No

What is the member, doctor, hospital, health care professional, or company's name you would like to report?

What is their phone number?

What is their address?

Suite/Apartment, if applicable

City

State

ZIP Code

What is the Tax ID, if applicable

What is the name of the person this claim is about?

First Name

Initial

Last Name

What is the date of birth of the person who is insured?

What is the insured person's email address?

What is the insured person's phone number?

What state does the insured reside?

Who is the insurance company?

Member ID Number (can be found on the insurance card)

What is the claim number listed on the EOB ?

If applicable, what is the date of service that you believe the fraudulent event occurred?
This information can be found on your EOB .

Add additional dates of service
Add multiple dates of service in MM/DD/YYYY format separated by commas (ex: MM/DD/YYYY, MM/DD/YYYY)

Tell us why you believe health care fraud may have occurred:

I certify that the information I am submitting is true and correct to the best of my knowledge.

I certify that I am over the age of 13. Terms of Service

You can also report your concerns by calling member services or our fraud hotlines.

For security reasons, you will not be contacted regarding any conclusion.